Reporting to the Supervisor, TPA Claims, the Claims Analyst is responsible for the adjudication of medical claims in accordance with claim processing guidelines. We are seeking a dedicated and detail-oriented Group Benefit Claims Case management analyst to join our team. The successful candidate will be responsible for managing and processing group benefit claims, ensuring accuracy, compliance, and timely resolution. This role requires strong analytical skills, excellent communication abilities, and a commitment to providing exceptional service to our members.

WHO WE ARE:

Proudly independent and Canadian-owned, Cowan Insurance Group has been a true market leader in the insurance industry since 1927. With an extensive range of product offerings and integrated commercial and personal insurance, group benefits, and wealth management solutions, we provide our clients with outstanding customized, comprehensive insurance and risk management professional advice and placement.
Recognized as one of Canada’s Most Admired Cultures and a Canada’s Best Managed Companies Platinum Club Member, Cowan Insurance Group’s award-winning client-centric approach emphasizes innovation, excellence, and collaboration. Join our team as we prepare for our centennial celebration in 2027!

• Assess and process claims in accordance with company’s service standards, procedures,and insurance policy guidelines
• Obtain additional information needed to assess a claim - either through the provider or the subscriber;
• Assist in identification and actualization of cost containment opportunities
• Handle claim enquiries ranging from basic to complex in nature
• Seek advice from designated team members on complicated cases or claims above authority limit
• Identify and investigate claims for possible abuse and fraud
• Utilizes all applicable system functions available ensuring accurate and timely claim processing service
• Escalate unresolved claims complaints and high costs claims to the supervisor for guidance
• Continually work to improve best practices procedures and standards